Rejection Sensitive Dysphoria for ADHD Adults: What It Is and How to Cope

Neurodivergence deals a lot of cards that can be tough to cope with. Among the most challenging are the emotional ups and downs that can plague ADHDers, especially those with the inattentive subtype. One such emotional challenge is rejection sensitive dysphoria, or RSD.

Defined as extreme emotional reaction to experienced or perceived rejection, failure, or criticism, RSD is incredibly painful to live with. It’s a deeply misunderstood symptom that can contain a lot of shame and confusion, especially if you’ve grown up being told you’re too sensitive or wonder why things hurt you more intensely than you think they should.

As an ADHD therapist and coach, I work with folks with rejection sensitive dysphoria to help them understand its far-reaching impacts on emotional well-being, relationships, and overall life. Here, learn about what RSD is and how to cope with the struggles.

What Is RSD? 8 Signs You Have Rejection Sensitivity Dysphoria

RSD – rejection sensitivity dysphoria – is an oft-overlooked symptom that occurs in many people with ADHD, especially women. Here are 8 signs you have rejection sensitive dysphoria. 

1. Intense Emotional Reactions

• Overwhelming sadness or despair: You feel an intense sense of sadness or despair in response to perceived or experienced rejection, criticism, or failure.
• Severe anxiety or panic: Just the thought alone of being rejected or criticized causes significant and lasting anxiety or panic, even in situations that others might not find distressing.

2. Extreme Sensitivity to Criticism

• Overinterpreting feedback: You take neutral or constructive feedback as harsh criticism or outright rejection, even if you know better intellectually. 
• Avoidance of criticism: You go out of your way to avoid situations where you could be criticized or rejected, which can lead to missed life or job opportunities.

3. Anger or Rage in Response to Rejection

• Explosive anger: Strong anger or rage surface when you sense that you've been rejected or criticized, and sometimes you behave impulsively in response.
• Holding grudges: You hold grudges against people who have rejected or criticized you.

4. Low Self-Esteem and Self-Worth

• Constant self-doubt: You frequently question your worth or abilities, often assuming others – both strangers and loved ones – dislike you or think poorly of you.
• Negative self-image: You never feel like you’re good enough, and your self-esteem is low as a result.

5. Social Withdrawal or Avoidance

• Avoiding social situations: You avoid social interactions or relationships – even if you simultaneously crave them – to protect yourself from potential rejection, criticism, or embarrassment.
• Isolation: You isolate yourself, particularly when you’re feeling extra vulnerable, withdrawing from friends, family, or colleagues from fear of judgment or rejection.

6. Perfectionism

• Fear of making mistakes: In order to avoid the excruciating pain of criticism or rejection, you attempt to appear outwardly perfect in everything you do.
• Inability to accept failure: Even minor mistakes might feel like devastating failures, reinforcing the fear of rejection. This can prevent you from starting anything you worry you won’t be great at right out the gate. 

7. Physical Symptoms

• Somatic complaints: Some people with RSD experience physical symptoms and chronic pain – e.g. headaches, stomachaches, low back pain, or general fatigue – as a result of hypervigilance and distress related to rejection.

8. Impact on Relationships

• Difficulty maintaining relationships: Relationships are strained due to your intense reactions to perceived slights, making it hard to maintain healthy, long-term connections.
• Constant need for reassurance: You frequently seek reassurance from friends, partners, and loved ones, needing constant affirmation that you are liked or valued.

How to Cope With Rejection

Coping with rejection is often difficult no matter who you are. But for people with RSD, it’s particularly painful – and can result in emotional shutdowns, patterns of behavior that don’t feel good, isolation, fractured relationships, and intense loneliness.

Many of my clients see these patterns playing out in their lives and don’t understand why they continue to be so sensitive or need so much reassurance or hold a fierce grudge against their best friend, who didn’t text them back for a week.

So how can you cope? Here are some strategies to try today.

Develop self-awareness. Do you know what triggers your RSD? Are there certain relationships or situations that set it off? Try noticing and keeping track of your big emotional reactions so you can become more aware of them.

Challenge negative thoughts. When you notice yourself feeling spiraly and having irrational or exaggerated emotions, take a second to challenge these thoughts. Ask yourself if there’s evidence to support these beliefs or if you might be misinterpreting the situation. Can you remind yourself in the moment that making a mistake or receiving criticism does not define your worth?

Practice emotional regulation skills. Try grounding yourself into the present moment with deep breathing, journaling, getting out and moving your body, or noticing 5 things you can see, hear, and feel. All of these emotion regulation skills can help you build resilience and dial down the emotional intensity of the moment. 

Talk (and coregulate) with loved ones. If you’re struggling with rejection or criticism from someone you care about and trust, tell them what’s going on for you. Express your feelings and ask for clarification before assuming they’ve rejected you. This type of coregulation with others can help others understand you better and help you feel safer in relationships.

Support For Rejection Sensitive Dysphoria

As I’ve talked about before, many people who grew up with non-hyperactive ADHD symptoms weren’t properly evaluated or treated. Unfortunately, if you don’t fully understand your neurodivergence, it’s easy to assume your symptoms are intrinsic faults. Even if you do understand your neurodivergence, a lot of symptoms are deeply baked in and take a long time to unravel from your life and habits. As a result, many of my clients feel a lot of shame and “not enoughness” in their lives.

I understand how isolating, lonely, exhausting, and frustrating living with RSD can be. If you want support lowering the anxiety and stress around rejection and criticism, I’m here to help.

I offer individualized ADHD therapy and coaching to help neurodivergent people with RSD learn how to practice self-care, build internal resilience, reframe rejection, and find healthy tools to cope with painful situations. Together, we can help you:

• Get to the root of your challenges
• Question your harmful beliefs
• Implement cognitive behavioral therapy modalities to find ways to overcome the obstacles you face
• Practice self-compassion
• Develop a support system
• Set healthy boundaries
• Improve communication 
• Decrease feelings of loneliness and pain
• Lower overall stress
• Feel worthwhile, lovable, and good enough

Learn more about my therapy services (including EMDR and talk therapy) if you’re located in Idaho, Iowa, or South Carolina. For all other locations, check out my coaching services. My coaching program offers all the same expertise, tools, and guidance as therapy in a more direct and goal-oriented approach that you can benefit from anywhere. 

Reach out today to schedule a free, no-obligation consultation. Let’s start building a better future together.